MEDICARE: MRS. ANAHIT G MATEVOSYAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	A69447	CA

General Provider Information

NPI Number	:	1255463899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANAHIT G MATEVOSYAN MD

Provider Business Mailing Address
First Line	:	100 N BRAND BLVD STE 630
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-2641
Country	:	US
Telephone Number	:	818-476-0132
Fax Number	:	818-476-0119

Provider Business Practice Location Address
First Line	:	100 N BRAND BLVD STE 630
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-2641
Country	:	US
Telephone Number	:	818-476-0132
Fax Number	:	818-476-0119

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	02/09/2022

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